The family of a teenager who was told he needed braces after an orthodontic assessment in Dublin told Gript of their disbelief after being told they would have to wait four and a half years for braces under HSE orthodontic care.
Around a third of children need orthodontic treatment, according to the HSE, with treatment often involving the use of braces to straighten crooked, crowded or protruding teeth, to close gaps between teeth or correct the bite. Treatment usually lasts from 18 months to 2 years, with orthodontist visits scheduled every 6 to 8 weeks.
While private treatment is widely available, fees for private orthodontic treatment usually start at around €3,500 but can be much higher, according to the HSE.
After being told their child was suitable for HSE orthodontic care, the family said they were delighted – however, their hopes were immediately dashed when the orthodontist told them their son would have to be put on a waiting list which had a waiting time of four and half a year. The family say they will now have to keep it private, as they did for another of their children, which they estimate will cost around €4,500.
Speaking to us, the child’s father said that by the time his teenage son received treatment under the HSE, he would be an adult.
“Four and a half years – that’s a long time. She is thirteen. It was probably the second time he had been seen by the dental service in his life – and the dentist said he would probably need orthodontic work, so he was referred to an orthodontist in Dublin.
“Everything was fine, and a week or two later, we went on the date. They told us, “Look, everything will be covered, no problem” – so I said that’s great. My wife and I both work, but this was a big relief.
“The dentist said, ‘If the extraction doesn’t fix it, he’ll probably need orthodontic work, but the waiting list is four and a half years.’
“He’s thirteen at the moment, so he’ll be eighteen by the time they look at him. I was shocked, I thought he was joking.”
The Dublin dad described an “awkward silence” that fell in the orthodontist’s office when he was told about the long wait time.
“The nurse was there too, just looking at the floor. They probably tell people this day in and day out. We feel serious action is needed here.”
Figures released in December 2021 revealed that more than 13,200 children across the State were waiting for emergency orthodontic treatment. The information was released in response to a question from Deputy David Cullinene, with the HSE saying at the time that demand for services was exceeding capacity.
To make matters worse for the parent who spoke to Gript, a few weeks after the appointment, the family received a letter telling them that orthodontic treatment could not be provided by the HSE at all.
“They said it’s because of waiting lists and because they can’t find the staff. Essentially, they were saying the care was covered, but they couldn’t get anyone to do it.”
“I went into them and asked what was going on, because they said the treatment could be covered – but the orthodontist apologized and said, ‘Look, we don’t have the staff to do it.’ I asked if I did the treatment for my son privately would I be reimbursed, but the orthodontist said no. It just seems like a very Irish solution to the problem,” he added.
The parent said the reality at the moment is that many families are currently struggling in Ireland, adding, “I’m sure I’m just one of many – I’m sure other people are being told the same thing. “
“THE COUNTRY IS NOT MOVING VERY WELL”
But the dad told Gript it “just seems ridiculous” – adding that the family were told they would be forced to stay private just days after An Taoiseach Leo Varadkar announced, during COP28, that the Irish government would start providing 225 million euros per year, starting next year, until hoist climate change, with a portion of the money allocated to countries abroad that are “most affected” by climate change.
“I just thought, couldn’t you spend some of that on vital services here, like making sure people have access to dentists?” said the parent. “I guess our experience is symptomatic of a larger issue. In short, the country is not being run very well at the moment and I think there are a lot of people who are very disappointed.”
After paying thousands for his daughter’s braces recently, the parent said that while he’s willing to invest the money in his son’s orthodontic care, it just seems like an extra “unnecessary and unexpected” expense, which he says “makes no sense ».
“To put up a four-and-a-half-year waiting list is beyond ridiculous,” he said. He also said that “the government is advertising asylum to people from countries all over the world, even where there is no war, while we can’t even provide basic services and healthcare for the people who live here by paying taxes – it doesn’t make sense. There’s something slightly ridiculous about it all.”
“Surely,” he added, “there has to be some benefit to being a citizen of this country, and you’d like to think you’d be given some sort of priority.”
“I think we need to start by fixing the problems that normal people face in this country. We can’t fix the whole world. We definitely have to start at home first. A lot of people struggle, and there’s no debating that.
“We hear that we are one of the richest countries in the world, but I honestly wonder about that. Maybe on paper, but in real terms, many people are barely getting by. I’m sure we are just one of many families facing unnecessary, large bills.
He said getting a letter saying the treatment couldn’t be done at all was “pretty obvious”, adding that his son, who needed a tooth extracted, also couldn’t get it done at the original dentist’s office.
“When the dentist told us they wouldn’t be able to remove the tooth after about two months, I honestly felt like we had wasted our time. We were told there was no staff to do the job. You just wonder, “What’s going on here?” You take time off work to go on these dates, and it feels like a stand-out exercise. This seems to be completely irrelevant to these dentists as they know they are not going to provide the treatment.”
“We’ll just have to go and pay for it ourselves. That’s the bottom line. It would be nice if you could claim the money back, but there doesn’t seem to be a way to do that according to the pros. I just feel like that’s part of the bigger picture about how things are going right now. I was honestly shocked by the situation,” he added.
80% OF “OUT OF POCKET” DENTAL COSTS
The issue of the lack of dentists and dental staff and long waiting times has been raised in the past in Oiracht. In July, a Joint Committee on Health debate heard that oral health was not being prioritized for promotion, funding or service delivery nationally. Fintan Hourihan, Chief Executive of the Irish Dental Association (IDA), told the committee, which discussed the IDA’s strategic workforce plan, that according to the CSO, 80% of dental care spending in Ireland is spent on his pocket.
Mr Hourihan said this was indicative of two things: that government help for the cost of dental care is “extremely limited compared to other health conditions”.
“More worryingly,” he said, “it shows that good oral health is closely linked to socio-economic status, with oral diseases and conditions disproportionately affecting the poor and vulnerable members of society across the life cycle.”
Mr Hourihan went on to report “chronic delays” in the delivery of the school screening program and that staffing and resources in the dental sector were fast becoming an even bigger problem for patients accessing dental care. He referred to research carried out by the Irish Dental Association in September 2021, which showed “in the strongest terms” that the majority of vacancies in the dental sector were not being filled.
“At that time, two-thirds of the practices that tried to recruit dentists in the previous 12 months couldn’t fill the vacancy, and neither did half of the practices that tried to recruit nurses or hygienists,” Mr Hourihan said.
“Two-thirds of dentists said staff shortages had an impact on patient access to dental care at their practice, and two-thirds said their ability to treat emergency appointments had declined in the past year,” he added.
Mr Hourihan also said that in April 2023, one in four dentists said they were currently unable to see new adult patients – while four in five dentists said they did not have the capacity to see new patients, including children .
He said the situation was “just as tough, if not more”, in the public sector, where the HSE is obliged to provide childcare and an orthodontic service. Here, he said, recruitment and resourcing challenges arose from policy decisions which Mr Hourihan said reflected “the very low priority placed by the Department of Health and the HSE on dental provision”.
KIDS DON’T SEE THE DENTIST UNTIL ’16 OR 17
“The health minister himself told us recently that the state has a blind spot when it comes to dentistry and oral health,” he continued.
“Our question to the committee today is what will it take for the State to open its eyes to the scale and urgency of the crisis it consistently chooses to ignore in order for dental health to finally be recognized as an integral part of general health. My colleagues will tell the committee in no uncertain terms that they cannot hire enough dentists.
“They’ll say their patients can’t get an appointment fast enough. I have no doubt that every member has come to today’s meeting with stories from their own constituencies and communities about how difficult it is for people to access care.”
In November, Sinn Féin TD Brian Stanley spoke of how dental services in Laois and Offaly had become “chronic”. Mr Stanley told the Dail how “there was no continuity” as he referred to the schools’ schedule, which saw children not being seen at primary school. TD said the children didn’t see each other until the third year of high school, “if they’re lucky,” adding that it’s “often the fifth year” before they see a dentist.
“The 16 and 17-year-olds are only now being seen. This is a problem because exports may be needed. Losing teeth is not preventative action,” he said. TD said that while “efforts have been made” to recruit, it is difficult to recruit dentists in Ireland.
“Recruitments are taking place abroad. We train them but we don’t employ them. New dental graduates need to see that there are opportunities and a career path. We need to fix this by having a public dental system. I’m not an ideologue about it. I am only practical. We cannot rely on the model we have,” he added.
